State Health Care in Hawaii Since 1975

While the federal health care reform bill passed in the House of Representatives last night, Hawaii and Massachusetts have had state regulated health care since 1975 and 2006 respectively.

Whether you support government regulated health care or not, there is a good chance it will soon be an option for most Americans (the bill still has a number of steps before it is official). In the meantime, let’s have a look at the impact of health care reform on two other states.

Depending on where you get the numbers from, 85-89% of Americans have health insurance.

Before 1975, 70% of Hawaiians had health insurance, which made it the highest insured state at the time. On January 1, 1975 the Hawaii Prepaid Health Care Art was passed, bringing the state to 92% coverage.

In Massachusetts, the introduction of State health care raised the insurance rate to approx 94% of residents in 2006. The following year, it went up to 97%. In the next two years it dropped a point and Massachusetts now has the lowest number of uninsured residents at 4.1%.

The Hawaiian and Massachusetts systems are quite different from each other. One of the key differences is who pays for it. In the Hawaiian system, employers are required to provided health insurance to employees who work more than 20 hours per week.

In Massachusetts, citizens are required to pay for their own insurance, although there are exemptions for some people, such as low income residents. Massachusetts employers are required to make a fair contribution to employee health care, not exceeding $295 per employee per year. The money paid by employers goes into a central fund which provides care for low-income and other qualified residents.

Massachusetts’ system has been very successful at improving the number of residents that have coverage while spending from the health safety net fund dropped 38% as more people became insured. Perhaps a downside was that it was too successful too quickly; there have been complaints that the health care infrastructure and staff are overwhelmed with business and wait times have increased.

The Hawaiian system has been very successful at increasing overall coverage while reducing spending and hospital visits due in part to heavy emphasis on preventive care.

There is a lot of confusion about what is actually in this new federal bill. If you want a better understanding of it, you can read a one page overview or the complete bill at the White House website: click here